What Does ePrescribing Mean for Patients? A Case Study of the Perspectives of Hospital Renal Patients

Lisa Lee, Robin Williams, Aziz Sheikh

Abstract


BACKGROUND: Hospital ePrescribing systems are expected to improve quality of care for patients, yet the perspectives of patients themselves have seldom been explored in the context of ePrescribing deployments.

OBJECTIVE: We sought to understand the significance of ePrescribing for patients through a case study of renal in-patients on a hospital ward, before and after the introduction of an ePrescribing system.

METHODS: Three data sources were drawn on as part of the case study: interviews with representatives from national patient groups (n = 10), in-patients on a renal ward (n = 11 pre-implementation; n = 12 post-implementation) and fieldnotes (n = 25) of observations made on the case study ward. Data were analysed thematically focusing on: (1) perceived benefits of ePrescribing; (2) patient awareness and understanding of the medications prescribed and (3) patient views on medicines reconciliation at admission and discharge.

RESULTS: While ePrescribing was viewed positively overall, its implementation in the case study site failed to address the lack of patient involvement in the prescribing process and poor medication counselling upon discharge. Importantly, the limited impact of the ePrescribing system in these particular areas appeared to be the result of institutional and cultural practices rather than solely technological factors.

CONCLUSIONS: The introduction of ePrescribing systems offers new opportunities to improve sharing of knowledge and communication with all those involved in the patient’s care pathways, including patients, carers and healthcare professionals across diverse care settings. Achieving this will, first and foremost, require significant cultural and policy shifts in how the patient’s role is perceived by clinicians in relation to medicines management.


Keywords


health information technology, medicines management, patient satisfaction

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References


Cresswell K, Worth A and Sheikh A. Comparative case study investigating sociotechnical processes of change in the context of a national electronic health record implementation. Health Informatics Journal 2012;18(4):251–70. http://dx.doi.org/10.1177/1460458212445399. PMid:23257056.

Huckvale C, Car J, Akiyama M, Khoja T, Bin Khalid A, Sheikh A et al. Information Technology for patient safety. Quality and Safety in Health Care 2010;19:25–33. http://dx.doi.org/10.1136/qshc.2009.038497. PMid:20693213.

Kaushal R, Shojania KG and Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Archives of Internal Medicine 2003;163:1409–16. http://dx.doi.org/10.1001/archinte.163.12.1409. PMid:12824090.

Smith DH, Perrin N, Feldstein A, Yang X, Kuang D, Simon SR et al. The impact of prescribing safety alerts for elderly persons in an electronic medical record: an interrupted time series evaluation. Archives of Internal Medicine 2006;166:1098–104. http://dx.doi.org/10.1001/archinte.166.10.1098. PMid:16717172.

Department of Health. Discharge from Hospital: Pathway, Process and Practice. London: Department of Health, 2003.

Moore C, Wisnivesky J, Williams S and McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. Journal of General Internal Medicine 2003;18:646–51. http://dx.doi.org/10.1046/j.1525-1497.2003.20722.x. PMCid:PMC1494907.

NHS Connecting for Health. Electronic Prescribing in Hospitals – Challenges and Lessons Learned. London: NHS Connecting for Health, 2009.

Crowe S, Cantrill JA and Tully MP. Shared care arrangements for specialist drugs in the UK: the challenges facing GP adherence. Quality and Safety in Health Care 2010;19(6):e54.

Schade CP, Sullivan FM, de Lusignan S and Madeley J. e-Prescribing, efficiency, quality: lessons from the computerization of UK family practice. Journal of American Medical Informatics Association 2006;13:470–5. http://dx.doi.org/10.1197/jamia.M2041. PMid:16799129; PMCid:PMC1561797.

Robertson A, Cresswell K, Takian A, Petrakaki D, Crowe S, Cornford T et al. Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. British Medical Journal 2010;341:c4564. http://dx.doi.org/10.1136/bmj.c4564. PMid:20813822; PMCid:PMC2933355.

Sheikh A, Cornford T, Barber N, Avery A, Takian A, Lichtner V et al. Implementation and adoption of nationwide electronic health records in secondary care in England: final qualitative results from a prospective national evaluation in “early adopter” hospitals. British Medical Journal 2011;343:d6054. http://dx.doi.org/10.1136/bmj.d6054. PMid:22006942; PMCid:PMC3195310.

Cresswell K, Coleman J, Slee A, Morrison Z and Sheikh A. A toolkit to support the implementation of electronic prescribing systems into UK hospitals: preliminary recommendations. Journal of the Royal Society of Medicine 2014;107(1):8–13. http://dx.doi.org/10.1177/0141076813502955. PMid:24108534.

Cresswell K, Coleman J, Slee A, Williams R and Sheikh A. Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals: a questionnaire study. PLoS One 2013;8(1):e53369. http://dx.doi.org/10.1371/journal.pone.0053369.

Cresswell K, Bates DW and Sheikh A. Ten key considerations for the successful implementation and adoption large-scale health information technology. Journal of American Medical Informatics Association 2013 [Epub ahead of print]. http://dx.doi.org/10.1136/amiajnl-2013-001684.

Robertson A, Cornford T, Barber N, Avery A, Sheikh A and NHS Care Records Service Evaluation Team. The NHS IT project: more than just a bad dream. Lancet 2012;379(9810):29–30. http://dx.doi.org/10.1016/S0140-6736(12)60023-3.

Penoyer DA, Cortelyou-Ward K, Noblin AM, Bullard T, Talbert S, Wilson J et al. Use of electronic health record documentation by healthcare workers in an acute care hospital system. Journal of Healthcare Management 2014;59(2):130–44.

Hincapie A, Warholak T, Altyar A, Snead R and Modisett T. Electronic prescribing problems reported to the Pharmacy and Provider ePrescribing Experience Reporting (PEER) portal. Research in Social Administrative Pharmacy 2014;10(4):647–55. http://dx.doi.org/10.1016/j.sapharm.2013.08.007. PMid:24139956.

Rose D, Richter L and Kapustin J. Patient experiences with electronic medical records: lessons learned. Journal of the American Association of Nurse Practitioners 2014;26(12):674–80. http://dx.doi.org/10.1002/2327-6924.12170.

Takian A, Sheikh A and Barber N. We are bitter, but we are better off: case study of the implementation of an electronic health record system into a mental health hospital in England. BMC Health Services Research 2012;12:484.

NHS England. Safer Hospitals, Safer Wards: Achieving an Integrated Digital Care Record, 2013. Available from: http://www.england.nhs.uk/wp-content/uploads/2013/07/safer-hosp-safer-wards.pdf (last accessed June 2015).

Asan O, Smith P and Montague E. More screen time, less face time – implications for EHR design. Journal of Evaluation in Clinical Practice 2014;20(6):896–901. http://dx.doi.org/10.1111/jep.12182. PMid:24835678.

Makam AN, Lanham HJ, Batchelor K, Moran B, Howell-Stampley T, Kirk L et al. The good, the bad and the early adopters: providers’ attitudes about a common, commercial EHR. Journal of Evaluation in Clinical Practice 2014;20(1):36–42. http://dx.doi.org/10.1111/jep.12076. PMid:23962319.

Currie WL and Seddon JMJ. A cross-national analysis of eHealth in the European Union: some policy and research directions. Information and Management 2014;51(6):783–97. http://dx.doi.org/10.1016/j.im.2014.04.004.

Hartmann Hamilton AR, Anhøj J, Hellebek A, Egebart J, Bjørn B and Lilja B. Computerised Physician Order Entry (CPOE). Studies in Health Technology and Informatics 2009;148:159–62. PMid:19745246.

Goldzweig CL, Orshansky G, Paige NM, Towfigh A, Haggstrom DA, Miake-Lye I et al. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes. Annals of Internal Medicine 2013;159(10):677. http://dx.doi.org/10.7326/0003-4819-159-10-201311190-00006. PMid:24247673.

Anthony D and Campos-Castillo C. Do health care users think electronic health records are important for themselves and their providers?: exploring group differences in a national survey. AMIA Annual Symposium Proceedings 2013;2013:42–9. http://dx.doi.org/10.1109/ichi.2013.33.

Gu Y and Day K. Propensity of people with long-term conditions to use personal health records. Studies in Health Technology and Informatics 2013;188:46–51. PMid:23823287.

de Leon S, Silfen SL, Wang J, Kamara TS, Wu WY and Shih SC. Patient experiences at primary care practices using electronic health records. The Journal of Medical Practice Management 2012;28(3):169. PMid:23373154.

Bos LBE. Patient Empowerment: A Two Way Road. Wickramasinghe N, Bali RK, Suomi R and Kirn S (Ed) Critical Issues for the Development of Sustainable E-Health Solutions. Zurich: Springer Verlag, 2012, pp. 203–27. http://dx.doi.org/10.1007/978-1-4614-1536-7_14.

Baysari MT, Adams K, Lehnbom, EC, Westbrook JI and Day RO. iPad use at the bedside: a tool for engaging patients in care processes during ward rounds? Internal Medicine Journal 2014;44(10):986–90. Available from: http://dx.doi.org/10.1111/imj.12518. PMid:24989476.

NIHR ePrescribing Programme. Available from: http://www.cphs.mvm.ed.ac.uk/projects/eprescribing/index.html (last accessed March 2015).

Lincoln YS and Guba EG. The Only Generalization Is: There is No Generalization. Gomm R, Hammersley M and Foster P (Ed) Case Study Method. London: Sage, 2000, pp. 27–44.

Vira T, Colquhoun M and Etchells E. Reconcilable differences: correcting medication errors at hospital admission and discharge. Quality and Safety in Health Care 2006;15:122–6. http://dx.doi.org/10.1136/qshc.2005.015347. PMid:16585113; PMCid:PMC2464829.

Moore P, Armitage G, Wright J, Dobrzanski S, Ansari N, Hammond I et al. Medicines reconciliation using a shared electronic health care record. Journal of Patient Safety 2011;7(3):148–54. http://dx.doi.org/10.1097/PTS.0b013e31822c5bf9. PMid:21857238.

Mohsin-Shaikh S, Garfield S and Dean Franklin B. Patient involvement in medication safety in hospital: an exploratory study. International Journal of Clinical Pharmacy 2014;36(3):657–66. http://dx.doi.org/10.1007/s11096-014-9951-8. PMid:24777838; PMCid:PMC4019827.

Barber N, Rawlins M and Dean Franklin B. Reducing prescribing error: competence, control, and culture. Quality and Safety in Health Care 2003;12:i29–32. http://dx.doi.org/10.1136/qhc.12.suppl_1.i29. PMid:14645746; PMCid:PMC1765766.

The Royal Pharmaceutical Society of Great Britain. Moving patients, Moving Medicines, Moving Safely: Guidance on Discharge and Transfer Planning, 2005. Available from: http://psnc.org.uk/wp-content/uploads/2013/07/Moving20Medicines20new1.pdf (last accessed June 2015).




DOI: http://dx.doi.org/10.14236/jhi.v22i4.176

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